Timothy R Thaller, MD | |
614 E Grady St, Statesboro, GA 30458-2067 | |
(912) 764-9001 | |
(912) 764-3166 |
Full Name | Timothy R Thaller |
---|---|
Gender | Male |
Speciality | Urology |
Experience | 30 Years |
Location | 614 E Grady St, Statesboro, Georgia |
Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1407849706 | NPI | - | NPPES |
000829507B | Medicaid | GA | |
340016471 | Other | GA | RR MEDICARE |
782637 | Other | GA | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208800000X | Urology | 046818 (Georgia) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
East Georgia Regional Medical Center | Statesboro, GA | Hospital |
Memorial University Medical Center | Savannah, GA | Hospital |
Evans Memorial Hospital | Claxton, GA | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
East Georgia Urologic Clinic, Pc | 5698865863 | 2 |
East Georgia Hma Physician Management Llc | 7214068592 | 32 |
Entity Name | East Georgia Urologic Clinic, Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1801078381 PECOS PAC ID: 5698865863 Enrollment ID: O20071212000494 |
Entity Name | East Georgia Hma Physician Management Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1487983151 PECOS PAC ID: 7214068592 Enrollment ID: O20100630000504 |
Mailing Address | Practice Location Address |
---|---|
Timothy R Thaller, MD 614 E Grady St, Statesboro, GA 30458-2067 Ph: (912) 764-9001 | Timothy R Thaller, MD 614 E Grady St, Statesboro, GA 30458-2067 Ph: (912) 764-9001 |
Thomas A. Sorbera, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 1497 Fair Rd Ste 102, Statesboro, GA 30458 Phone: 912-764-9001 Fax: 912-764-3166 | |
Paul J Tilson, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 412 Northside Dr E, #500, Statesboro, GA 30458 Phone: 912-764-6808 Fax: 912-764-2436 |